Dr José Rizal (1861–1896) and the sociocultural aspects of mental health in the Philippines in the late 19th century – Psychiatry in history

Dr José Rizal (1861–1896) was a Philippine physician and writer who advocated for social justice in the later period of Spanish rule, culminating in his exile and execution by colonial authorities. Encompassing far-reaching subjects, Rizal's works are now mandatorily taught in Filipino educational institutions. Notably, despite specialising in ophthalmology, the physician–writer made intellectual contributions to psychiatry across scholarly and fictional publications, exploring social and cultural frameworks of mental health.

In an 1895 study entitled The Treatment of the Bewitched (La Curación de los Hechizados), Rizal investigated supernatural attitudes towards psychiatric disorders, analysing folk beliefs around ‘bewitchment’ in the Philippines. This condition was diagnosed when the basis of an illness could not be determined by traditional healers (herbolarios). ‘Bewitchment’ manifested in two forms, namely mangkukulam (witch) and manggagaway (sorcerer). Supposedly incurable, the former was ‘inborn or acquired through an illness’, rendering an individual ‘capable of hypnotising or casting a spell’. Solely affecting women, the latter could entail ‘a specific organic lesion’ or ‘the incorporation of the witch's spirit into the body of the mentally deranged patient’.

‘Bewitched’ individuals were heavily stigmatised and regarded as ‘scape-goats of the naïve, the malevolent, and the slanderers’. Repudiating these perspectives, Rizal accentuated rationality and compassion, arguing that the diagnosis and treatment of ‘bewitchment’ must instead be ‘consistent with the modern theories’ predicated on psychopathology. Correspondingly, he outlined the potential of psychotherapy, eschewing regressive and violent methods employed by herbolarios. Comparing idioms of ‘bewitchment’ with current diagnostic classifications is challenging. Nonetheless, Rizal exemplified how sociocultural components can shape psychiatric understanding, thereby aligning with modern notions.

Illustrating similar motifs, Rizal's fiction explores broader paradigms around mental health in the context of colonial hegemony. His novel, Noli Me Tángere (1887), outlines the repressive and inequitable conditions enforced by Spanish rule and the primacy of the Catholic Church, emphasising correlations between social injustices and psychopathology. For example, the character of Sisa experiences poverty, domestic violence and the disappearance of her sons owing to abuses and deceit by Catholic friars. Resultantly, she develops increasingly severe psychiatric symptoms, including delusions, hallucinations and memory loss, among others. Nevertheless, instead of receiving treatment or empathy, she is persecuted by the Spanish authorities and socially outcast.

Moreover, through Pilosopo Tasio in Noli Me Tángere, Rizal represents political resistance as a form of psychological deviation, highlighting the predominance of colonialist ideologies. Tasio is marginalised for expressing resistance towards ruling institutions, especially the Church. This ostracism has psychopathological associations, as Tasio himself acknowledges: ‘people believe that madness is when you don't think as they do, which is why they take me for a madman’. This characterisation shares some resemblances with later incidents of psychiatric politicisation that transpired elsewhere, with Tasio's transgressive opinions considered to be indicative of abnormal behaviour or ‘madness’.

Albeit reflective of contemporaneous conditions, Rizal's work provides preliminary insights into the wider dynamics of mental health, especially in relation to cultural idioms and colonialist influences. Many of these are pertinent to modern psychiatry, underscoring the importance of holistic, compassionate ideas underpinned by cultural sensitivity.